Provider Demographics
NPI:1356403653
Name:CHERRY, JASON ALEXANDER (MSPT,COMT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALEXANDER
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MSPT,COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S TELLER ST STE 270
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-7389
Mailing Address - Country:US
Mailing Address - Phone:303-274-2404
Mailing Address - Fax:303-274-2406
Practice Address - Street 1:325 S TELLER ST STE 270
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7389
Practice Address - Country:US
Practice Address - Phone:303-274-2404
Practice Address - Fax:303-274-2406
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC543878Medicare PIN